AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Serçin G., Kazım Ö. (2020) Natural Course of Isolated Pulmonary Valve Stenosis in Pediatric Patients. J. Clinical Cardiology and Cardiovascular Interventions, 3(2); Doi:10.31579/2641-0419/043
Citation: Serçin G., Kazım Ö. (2020) Natural Course of Isolated Pulmonary Valve Stenosis in Pediatric Patients. J. Clinical Cardiology and Cardiovascular Interventions, 3(2); Doi:10.31579/2641-0419/043
Copyright: © 2020 Güven Serçin, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 26 December 2019 | Accepted: 08 January 2020 | Published: 13 January 2020
Keywords: pulmonary valve; stenosis; gradient; natural course
Aim:
The aim of our study is to be able to predict the prognosis of patients with isolated pulmonary valvular stenosis on the basis of age and degree of stenosis. Identification of the course of pulmonary stenosis of different age groups will significantly contribute both to the physicians and the relatives of the patient.
Material and Methods:
105 pediatric patients diagnosed with isolated pulmonary valvular stenosis were included in our study. We investigated the impact of the gradient of stenosis and the age at the time of diagnosis on the natural course of pulmonary stenosis. Mean follow-up time of the children was 19 months, 25.45±22.48 months. The patients were divided into four groups over their trans-valvular gradient degrees and<20 mmHg was defined as transient, 20-39 mmHg mild, 40-59 mmHg moderate, 60 mmHg and over as severe pulmonary stenosis.
Results:
Between two to five months, none of the moderate stenosis cases progressed unlike other patient groups. The decline in the final gradient versus initial gradient was significant in children between two to five months and six months to two years in our study, and yet there was no significant change of initial and final gradients in patients under one month, and at two years and over.
Conclusion: It would be reasonable to conclude that the progression of pulmonary valvular stenosis is benign in patients with pulmonary valvular stenosis under 40 mmHg of systolic gradient diagnosed after 6th month of life.
Valvular pulmonary stenosis (PS) is a condition characterized by obstruction to blood flow from the right ventricle to the pulmonary artery. PS can occur in isolation or be associated with other types of cardiac defects.
Valvular pulmonary stenosis was first described in 1761 by John Baptist Morgagni. It was reported that prevalence of pulmonary stenosis among all congenital cardiac malformations reached up to 10%.[1,2].
Koretzky in 1969 first discussed the thickening of cusps from inside and a mucoid dysplastic valve. [3] Majority of patients with Ullrich –Noonan syndrome have this type of pulmonary stenosis. [4]
Patients with mild and moderate pulmonary stenosis with right ventricular pressure less than 60 mmHg may survive asymptomatically. Patients who have symptoms like congestive cardiac failure or paroxysmal dyspnea episodes in the first years of their lives are in the highest risk groups. [5,6]
Right ventricular hypertrophy may develop in case right ventricular pressure during rest remains >50 mmHg for a long time. Valvular stenosis does not increase after the 2nd decade, however, infundibular hypertrophy developing secondary to this condition may lead to the increase of the gradient. Progressive myocardial hypertrophy, fibrosis, dilatation and tricuspid regurgitation and dysrhythmia may develop. Mild or moderate pulmonary stenosis is hardly progressive. Life expectancy is normal when peak gradient is < 50 mmHg.
According to a study using cardiac catheterization, while systolic gradient from the right ventricle to the pulmonary arteries remained stable in majority of the patients, there was a significant increase in 14% and a significant decrease in 14% of the patients. A patient with mild pulmonary stenosis did not progress into severe pulmonary stenosis and 10% of the patients with moderate pulmonary stenosis reported to progress. It has been understood that most dramatic increase in stenosis occurred in children aged <2 years. Some of the patients had severe progression until the age 12. It is very difficult to predict progression in children aged <2 years at diagnosis. [6]
There is limited number of studies conducted with the small age groups. Our hospital is a maternity hospital, all neonates are physically examined and echocardiography is applied for those with suspicion of any pathology. The aim of our study is to be able to predict the prognosis of patients with isolated pulmonary valvular stenosis on the basis of age and degree of stenosis.
105 patients under follow-up with the diagnosis of isolated pulmonary valvular stenosis at Bakırköy Maternity and Pediatric Hospital, Department of Pediatric Cardiology were included in this study.
Diagnosis of isolated pulmonary valvular stenosis was made by using General ElectricVivid S5brand Doppler Echocardiography device. Medical records of 105 patients, who were diagnosed and followed-up between 2000-2010 at the Cardiology Clinic, were retrospectively examined and findings on the first echocardiographic investigation performed on the patients, age of the patients at diagnosis, findings on the last echocardiographic investigation and the need for invasive intervention were noted.
Patients with incomplete investigation, additional cardiac abnormalities and with abnormal ventricular function were excluded from the study. Patients with small patent ductus arteriosus and patent foramen ovale were included in the study.
Severity of pulmonary stenosis is graded on the basis of the peak gradient between the right ventricle and the pulmonary artery. If the peak gradient measured during normal cardiac output is < 20 mmHg, the classification is defined as transient, between 20-39 mmHg as mild, between 40-59 mmHg as moderate and ≥ 60 mmHg as severe. The classification based on the above-given gradients is valid only in patients with normal right ventricle systolic functions.
The study protocol was described to all patients and each participant provided informed consent and the study was approved by the local ethics committee of the university hospital (Protocol number: 09.2019.779).
Statistical Analysis
NCSS (Number Cruncher Statistical System) Statistical Software (Utah, USA) program was used for statistical analysis in assessing the data obtained from the study. While assessing the study data, besides descriptive statistical methods (Median, standard deviation, frequency), Kruskal-Wallis test was used for comparison of quantitative data and parameters among the groups. Mann-Whitney U test was used for comparing the parameters in between two groups. Chi-square test was used for comparison of qualitative data. Intraclass correlation analysis was used to investigate the relations between the parameters. p<0.05 was taken for statistical significance.
Results
The study was performed on 105 pediatric patients, 52 male (49.5%) and 53 female (50.5%) with isolated pulmonary stenosis. Age at diagnosis of these children varied between one day to 13 years with an average age at diagnosis of 13.28±27.71 months and median age of four months. The follow-up time of subjects ranged between seven days to ten years with an average of 25.45±22.48 months and median of nine months.
Age at diagnosis was underone month in 31 patients (29.5%), whereas it was between 2-5 months in 27 patients (25.7%), six months to two years in 33 patients (31.4%) and ≥ 2 years in 14 children (13.3%) (Table 1).
Table 2 shows the changes in final gradients of 31 children with the age under one month at diagnosis. 19.4% of these children (6/31) had transient initial gradient. In three of these children, gradient remained as transient at the final whereas the gradient was mild in three of them.
51.6% of the children (16/31) had mild initial gradients. Final gradient of nine children was transient whereas it remained mild in five patients, moderate in one and severe in one of them.19.4% of the children (6/31) had moderate initial gradient. Final gradient was mild in two of these children whereas it remained moderate in two of them and reached to severe level in two of them. 9.7% of the children (3/31) had severe initial gradient. Gradients in all of these children remained severe.
The changes in final gradients of a total of 27 children at the age of two months to five months at diagnosis, 11.1% (3/27) of them had a transient initial gradient. The gradient remained transient in two of these children and in one child it remained mild.
59.3% of the children (16/27) had mild initial gradient. Ten of these children reached transient stage at the final, four patients remained mild and two children developed moderate PS.
22.2% of them (6/27) had moderate initial gradient. Final gradient was transient in one of these children, mild in three and moderate in two of them.
7.4% of the children (2/27) had severe initial gradient. Final gradient of both children was moderate. (Table 3)
According to the changes between the initial and final gradients of 33 children at the age of six months to two years at diagnosis;
Initial gradients were transient in 36.4% of them (12/33) While final gradient of 10 in these children remained transient, two children’s gradient ended at mild level.
Initial gradient in 33.3% of the children (11/33) was mild. While final gradient of three in these children was transient, final gradient of seven children remained mild and one of them reached to the moderate level.
Initial gradient in 21.2% of the children (7/33) was moderate. While final gradient of four children was mild, one of them remained moderate and two of them reached to severe level.
Inital gradient in 9.1% of the children (3/33) was severe. While final gradient of one child regressed to transient, two of them remained severe. (Table 4)
The change in the gradients of 14 children at the age of two years and over at diagnosis is shown in Table 5.
Initial gradient in 21.4% of them (3/14) was transient. Two of them remained transient at the end and one child had mild final gradient. Initial gradient in 42.9% (6/14) was mild. Three of these children had transient final gradient and three of them had mild final gradient.
Initial gradient in 21.4% (3/14) was moderate. While the gradient of two of these children was mild at the final stage, one of them reached to the severe level.
Initial gradient in 14.3% of the children (2/14) was severe. Final gradient of both children remained severe.
There was no statistically significant difference at the final gradient versus the initial gradient in neonates (p>0.05).
The decrease observed at the final gradient versus the initial was highly statistically significant in children at the age of 2-5 months at diagnosis (p<0.01).
The decrease observed at the final gradient versus the initial was statistically significant in children at the age of 6 months-2 years at diagnosis (p<0.05).
There was no statistically significant difference at the final gradient versus the initial gradient in children at the age of two years and over at diagnosis (p>0.05) (Table 6)
Balloon valvuloplasty was performed on 11 patients in our study. Six of these patients (54%) had moderate pulmonary stenosis according to initial gradient whereas five of them (46%) presented with severe stenosis. Age of onset was under one month in three of the patients with severe pulmonary stenosis whereas one was at the age of ten months and the other at four years. Three patients with moderate initial gradients were at the age of one month and under, whereas the other three were between six months and to two years. Age of onset of patients having undergone balloon valvuloplasty was 9,8 ±15 months with a follow-up time of 5,8±5,9 months.
Studies investigating the progression of stenosis severity in patients with pulmonary valvular stenosis presenting with intact septum do not report any need for cardiac surgery in 95% of the patients with a mild initial gradient in 25-year follow-up. The gradient of moderate or severe pulmonary stenosis tends to increase with age.
Mild to moderate pulmonary valvular stenosis cases are generally associated with a good prognosis. Severe and moderate stenoses with an onset before four years of life are reported to associate with secondary infundibular stenosis resulting in a progressive worsening of the condition and poor prognosis. Severe obstruction may impair the right ventricle in years causing arrhythmias and premature mortality.
In a study on 51 infants with asymptomatic pulmonary valvular stenosis, Anandet al. observed a rapid progression in six (15%) of the patients. Three of these six patients reached surgical gradient level in six months and the remaining three after the age of two [7].
In another study on 174 patients, Gielenet al reported 3% progression to severe stenosis in patients with a transient initial stenosis. The ratio of patients with mild and moderate stenosis was 10 % and 9%, respectively[8].
Another study reports cardiac catheterization in 184 of 261 patients with a significant gradient increase in only 26 (14%) of the patients. Only 22 children under the age of two years were included in this study. Investigators concluded that children under four years have a higher risk of progression when their initial gradient is already high [9]. The second ‘Natural History Study of Congenital Heart Defects’ trial followed patients with a gradient of 25 mmHg and under not detecting any increase in any of the subjects [10]. Both studies and other similar trials concluded that mild pulmonary stenosis is a static lesion that rarely progresses.
In a study by Rowland et al., 147 patients were followed-up detecting an increase equal to 20 mmHg and more in gradients of 16 patients (29%) out of 56 under one month of age. 80% of 21 patients under one month with a initial gradient under 20 mmHg remained stable, 63% of 19 patients with a mild initial gradient finished the study with a mild gradient level. Rest of the patients progressed to moderate and/or severe stage. [11].
Mild and moderate pulmonary valvular stenosis cases in our study between two months to two years have a benign prognosis. None of the patients with a transient initial gradient developed severe stenosis. 6% of the patients with mild stenosis and 23% of the ones with moderate stenosis developed severe stenosis. There is no difference in terms of time of follow-up of these patients. 11 of 105 patients required balloon valvuloplasty, all of whom were diagnosed under four years of life. In six of the 31 patients (29,5%) under one month, initial gradient was <20 mmHg, all of whom reached mild and transient stage by the end of the study. Gradient level of 87% of 16 patients with a mild initial gradient remained the same or regressed. Rest of the patients progressed to moderate and severe stage. Corroborating with Rowland’s study, the subjects in our study under one month with severe initial gradients required surgery.
Derrick et al reported that 25% of the patients diagnosed with mild pulmonary stenosis at the neonatal period developed significant stenosis in the time to follow to the degree that required surgery in half of them [12] in our study, two of the 16 patients (13%) diagnosed with mild pulmonary stenosis during neonatal period presented with a progressed stenosis. Nevertheless, none of these patients required balloon valvuloplasty.
While 88% of patients with mild stenosis between two to five months have not presented with a progression in the level of their stenosis, 12% progressed to moderate stenosis. 34% of moderate stenosis remained stable whereas 66% presented a decrease in the degree of stenosis. All severe cases regressed to moderate stage. None of the patients in this age group progressed. 9% of the patients in the age group of six months to two years with mild stenosis progressed to moderate stage whereas 91% remained stable or regressed to transient stenosis. While 28% of the moderate group progressed, 14% remained stable and 57% regressed to a lesser degree of stenosis. Mild stenosis cases above two years did not progress and only 33% of moderate cases progressed to a higher degree of stenosis. As far as the subjects between two to five months are concerned, none of the moderate stenosis cases progressed unlike other patient groups. The decline in the final gradient versus initial was significant in children between two to five months and six months to two years in our study, and yet there was no significant change of initial and final gradients in patients under one month, and at two years and over. This may be explained with the fact that the body weight increases by two folds between two to five months, during which cardiovascular structures grow with the body, whereas the timeline between six months and two years is the period where the body grows exponentially. Valve outgrowth unproportional to somatic growth may be responsible for gradient changes requiring close follow-up.
It would be reasonable to conclude from the study that the progression of pulmonary valvular stenosis is benign in patients with pulmonary valvular stenosis under 40 mmHg of systolic gradient diagnosed after 6th month of life. Patients diagnosed at neonatal period should be followed more closely and frequently regardless of the degree of their stenosis.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
